Journal Article

Immunoglobulin Replacement Therapy Versus Antibiotic Prophylaxis as Treatment for Incomplete Primary Antibody Deficiency

de Vries Esther, Smits, Bas M, ten Berge Ineke J M, van der Flier Michiel, Simon, Anna, van Montfrans Joris M, Sanders Lieke E A M, Bredius Robbert G M, Martin, van Hagen P, Ellerbroek, Pauline M, Kleine, Budde Ilona, Rutgers Bram, Marcel, van Deuren, van Dissel Jaap T, Nieuwhof, Chris, Kuijpers, Taco W

2021

Overview

BackgroundPatients with an IgG subclass deficiency (IgSD) ± specific polysaccharide antibody deficiency (SPAD) often present with recurrent infections. Previous retrospective studies have shown that prophylactic antibiotics (PA) and immunoglobulin replacement therapy (IRT) can both be effective in preventing these infections; however, this has not been confirmed in a prospective study.ObjectiveTo compare the efficacy of PA and IRT in a randomized crossover trial.MethodsA total of 64 patients (55 adults and 9 children) were randomized (2:2) between two treatment arms. Treatment arm A began with 12 months of PA, and treatment arm B began with 12 months of IRT. After a 3-month bridging period with cotrimoxazole, the treatment was switched to 12 months of IRT and PA, respectively. The efficacy (measured by the incidence of infections) and proportion of related adverse events in the two arms were compared.ResultsThe overall efficacy of the two regimens did not differ (p = 0.58, two-sided Wilcoxon signed-rank test). A smaller proportion of patients suffered a related adverse event while using PA (26.8% vs. 60.3%, p < 0.0003, chi-squared test). Patients with persistent infections while using PA suffered fewer infections per year after switching to IRT (2.63 vs. 0.64, p < 0.01).ConclusionWe found comparable efficacy of IRT and PA in patients with IgSD ± SPAD. Patients with persistent infections during treatment with PA had less infections after switching to IRT.Clinical ImplicationGiven the costs and associated side-effects of IRT, it should be reserved for patients with persistent infections despite treatment with PA.

• Publisher: Springer Nature B.V
• Subject: Adverse events / Antibiotics / Cotrimoxazole / Disease prevention / Immunoglobulin G / Immunoglobulins / Infections / Patients / Persistent infection / Polysaccharides